Assignment: Writing A Treatment Plan

Southside Community Services: Mrs. Bargas Case History

© 2018 Laureate Education, Inc. 1

Southside Community Services: Mrs. Bargas Case History Program Transcript [MUSIC PLAYING]

LINDA FORTE: Hi, Mrs. Bargas, I’m Linda Forte, the social worker assigned to your case. It’s nice to meet you. So what brings you in, today?

MRS. BARGAS: Well– I’ve been out of work about 3 months. And 2 weeks ago, my husband had a stroke. He’s still in the hospital. So it’s been– a lot, all at once. And the money– I don’t know how going to pay the bills, or the rent. We cannot lose our home. We have five children.

LINDA FORTE: Has this been hard on them? It sounds like you’ve been going through a lot since losing your job and your husband being in the hospital. I can understand how you can feel stressed and concerned.

MRS. BARGAS: My daughter Amy– she’s my oldest– she’s been having the hardest time. She’s cutting classes at school and she’s failing two of her courses.

LINDA FORTE: So how did you hear about our agency and how can I help?

MRS. BARGAS: Well, my pastor said that you could help me find a job and maybe help with the rent money. And maybe Amy could– speak to somebody.

LINDA FORTE: OK. Has your daughter, Amy, has she ever expressed any interest in hoping to speak to somebody about her problems?

MRS. BARGAS: Maybe. I don’t know. I haven’t really mentioned it to her. But my pastor thinks it’s a good idea.

LINDA FORTE: Has Amy ever spoken to the social worker at her school, before?

MRS. BARGAS: No, I don’t think so.

LINDA FORTE: OK. That’s fine. We can definitely talk about getting Amy some help. But first, why don’t we talk a little bit about work experience. What kind of job are you hoping to find?

MRS. BARGAS: Well, before I married my husband, I worked as a nanny.

LINDA FORTE: OK. So why don’t we talk a little bit more about that, about who you worked for, and what kind of job duties you had.

MRS. BARGAS: Well, I was much younger when I was a nanny. Let me see, it was– more than 12 years ago. But I don’t think I could do that work, now. Maybe

Southside Community Services: Mrs. Bargas Case History

© 2018 Laureate Education, Inc. 2

I could work in an office. You know, I’m really good at working with people. Can you find me a job in an office?

LINDA FORTE: I don’t know. I work with a career counselor, here. She might be able to help you.

MRS. BARGAS: I don’t know how I’m going to pay the rent.

LINDA FORTE: I know right now is really tough for you.

MRS. BARGAS: I just don’t know what to do. Nothing has turned out the way I hoped it would. My whole life. I’m really worried about my daughter, Amy. She’s afraid to go to school. She loses her temper all the time. She yells at me and then locks herself in a room and she won’t speak. I am so confused. I don’t know what to do with her. I just– I don’t know.

LINDA FORTE: It’s OK to be upset. Mrs. Bargas? Are you OK?

MRS. BARGAS: I’m sorry, what?

LINDA FORTE: Are you all right?

[MUSIC PLAYING]

LINDA FORTE: Good news. I spoke with the career counselor and she has an available opening for you, tomorrow. She thinks she can help you find a job.

MRS. BARGAS: That’s great! Thank you so much. I was wondering, actually, there’s something else that you could help me with. I told you that my husband had a stroke. He’s going to need speech therapy. But it’s– we can’t afford it. And we don’t have any insurance. Is there any chance that you could call his doctor and see if my husband can get this therapy? He really needs it.

LINDA FORTE: I may be able to help. But I’m going to need to understand your husband’s situation a little bit better. Is there any way your husband would be willing to sign a release form, so I could talk to the doctor?

MRS. BARGAS: You can’t just call his doctor? I give you permission.

LINDA FORTE: I’m afraid not. According to HIPAA regulations, the doctor is not allowed to discuss your husband’s condition with me without his consent. Your husband could sign a release of information form, which would then make it possible for me to talk to his doctor. I recommend you go home and talk to your husband about whether he’d want to give his consent. Assignment: Writing A Treatment Plan

MRS. BARGAS: OK. I will. Thank you so much. You’ve been so helpful.

Southside Community Services: Mrs. Bargas Case History

© 2018 Laureate Education, Inc. 3

LINDA FORTE: Absolutely. And I look forward to seeing Amy next week.

MRS. BARGAS: Bye.

LINDA FORTE: Bye.

[MUSIC PLAYING]

Social support available for substance‐dependent mothers from families with parental substance abuse

Eli Marie Wiig*†, Astrid Halsa‡ and Bente Storm Mowatt Haugland§ *Institute of Clinical Medicine, SERAF, University of Oslo, Oslo, Norway, †Borgestadklinikken, KoRus Sør, Skien, Norway,

‡Lillehammer University College, Pedagogical and Social Studies, Lillehammer, Norway, and §Uni Health, Uni Research,

Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU West), Bergen, Norway

Correspondence: Eli Marie Wiig, Institute of Clinical Medicine, SERAF University of Oslo P.O. Box 1039 Blindern, Oslo, NO 0315, Norway Email: eli.marie. wiig@borgestadklinikken.no

Accepted for publication: November 2016

ABSTRACT

Substance‐dependent mothers, who have grown up with parental substance abuse, struggle during and after treatment to abstain from substances while trying to process traumatic experiences and integrate their family into society. The aim of this study was to explore the social support available for these mothers to help them stay abstinent and cre- ate safe family environments for themselves and their children. Using purposeful sampling, we approached nine mothers admitted for 1 year to a family ward at a substance abuse clinic and their significant others. Through in‐depth, qualitative interviews, first with the mothers, later with their significant others, we investigated characteristics of the avail- able social support. The findings indicated that the significant others had limited resources and were themselves exposed to adverse and cumula- tive psychosocial and socioeconomic risk factors. Their relationships with the mothers were, nevertheless, close, consistent and reliable. Supporting the existing social network should be an integrated part of the work of family welfare services aiming to help substance‐ dependent mothers from families with parental substance abuse to reha- bilitate and to integrate successfully into local communities. Assignment: Writing A Treatment Plan

INTRODUCTION

Substance‐dependent women who have grown up in families with substance abusing parents have major challenges to solve when they themselves become mothers, such as heightened risk for transferring sub- stance abuse or psychiatric problems to their offspring (Belsky et al., 2009) and establishing a safe and predict- able environment for their child without substance abusing caregivers or family members. We approached nine women admitted to a family ward at a substance abuse clinic to learn about the challenges these women face and how they understand their own situation. All mothers received inpatient treatment together with their child during the first year after giving birth. The aim of the treatment was twofold: learning to lead an abstinent life and becoming able to care for a child. The first paper from this study showed how these women’s life courses had so far been filled with experiences with substance abuse, traumatic events and insufficient developmental

support (Wiig et al., 2014). These findings are in line with Young et al. (2007) who described the adverse childhood experiences that may follow from parental substance use disorders (SUDs). Lindgaard (2011) and Haugland (2005) also show how these women’s ex- periences in childhood and adult life may have fostered feelings of shame, guilt, low self‐esteem and a chaotic lifestyle. Growing up with substance abusing parents may leave the offspring with serious deficits when it comes to parenting (Suchman et al., 2005). As the inter- nal working model of parenthood develops through childhood (Kanami et al., 2002), these women may need extra help with the parenting role. Becoming a par- ent is a big responsibility for any woman. The marginal- ization experienced by these women throughout childhood and adult life, as well as their own adverse childhood experiences, is likely to increase the chal- lenges they face in motherhood (Wiig et al., 2014). As many substance abusing mothers have partners who

Child and Family Social Work 2017, 22, pp 1246–1254 © 2016 John Wiley & Sons Ltd1246

doi:10.1111/cfs.12341

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are also substance dependent, they may lack an absti- nent partner to assist them in their parenting role and are left alone with the responsibility of caring for and raising their child (Banwell & Bammer, 2006).

A marginalized life without structure or abstinent friends may be a consequence of having been a harmful substance user and growing up in a family disrupted by parental substance abuse (Wiig et al., 2014). Byqvist (2011) and Dawe et al. (2008) claim that female sub- stance abuse is often accompanied by social isolation. The social isolation may be lessened during the inpatient treatment where the women receive support from pro- fessionals and fellow patients but may represent a chal- lenge in the rehabilitation of the mothers when they try to build a home for themselves and their child in a com- munity. Being discharged from an institution is a critical transition for substance abusers in general (Dahle & Iversen, 2011; Ilgen et al., 2008). Leaving a safe and controlled environment to establish an independent adult life in society may be particularly challenging for those who have never had a normal family life.

The mothers in our study had aspirations to lead an abstinent life, to establish a secure and stable life with a loving environment for their children and to integrate their family into society (Wiig et al., 2014). To manage these goals, they would need support. However, substance‐dependent women from substance abusing families may have partners and family members who struggle with substance dependence themselves, being unable to support the mother‐and‐child dyads.

Social support is defined as emotional (loving, car- ing), informational (advising, counselling) or practical assistance (financial help, babysitting) from significant others, such as family members, friends or work colleagues (Thoits, 2010). Perceived social support is influential for healthy psychological functioning (Thompson et al., 2006) and a key factor in creating nurturing and predictable environments for children (Mathiesen et al., 1999). Assignment: Writing A Treatment Plan

Suchman et al. (2005) found that the necessary growth and development may be possible for substance‐dependent women if they receive sufficient support, so their caregiving may be influenced by their perceived social support. Belonging to a family or having a network of friends or supportive neighbours may act as protective factors (Suchman et al., 2005). The care- giver’s social support influences the development of children, directly through providing social control, role models and social bridging to other people and indi- rectly through making mothers feel better (Boe & Schiefloe, 2007; Olstad et al., 2001). Social support is especially important for the offspring of parents at

risk from socio‐economic factors and stressful life situations (Kendler et al., 2005), like substance‐ dependent mothers with substance abuse in their family of origin (Banwell & Bammer, 2006; Dawe et al., 2008).

Even though research confirms that social support in general is beneficial, it may be of importance to evaluate the reciprocity of the relationship. Gouldner’s (1960) reciprocity norm dictates that one in the end is not sup- posed to gain at the expense of others’ beneficial acts. In- dividualswhoreceivemoresupportthantheyreciprocate may experience feelings of dependence, low self‐efficacy or low self‐esteem (Nurullah, 2012; Shrout et al., 2006).

Cohen(2004)suggeststhatisolatedindividualsinpar- ticularmaybenefit fromestablishingnewsocialcontacts, but there is also the possibility that those with strong feel- ings of isolation or relationships filled with ambivalence and conflict will be unable to expand their social net- works. Thus, Cohen (2004) underlines that services should facilitate and strengthen the bonds between the mothers and individuals in their natural social networks.

Substance‐dependent women with substance abuse in their family of origin may experience dilemmas with regard to their social network. They need support to stay abstinent and to take care of their child – at the same time they may need to distance themselves from their social network and family. Maintaining contact with parents, siblings, friends and former partners who continue to abuse substances may imply a substantial relapse risk in a rehabilitation process (Marlatt & Witkiewitz, 2009). Substance‐dependent mothers may also need to protect their children from exposure to the unpredictability and violence that close contact with friends and families with SUDs may imply (Dube et al., 2003; Perry, 2010; Wiig et al., 2014). Assignment: Writing A Treatment Plan

Increased knowledge of the social support available to substance‐dependent mothers from families with sub- stance abuse is important in understanding how the community can help these women stay abstinent and create safe family environments for themselves and their children. The aim of the present study was to explore the relationship between mothers with SUDs from families with parental substance abuse and their signifi- cant others. In particular, we wanted to investigate what kind of social support the significant others provided, and what additional social support was available for these mother‐and‐child dyads?